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Dealing with a medical emergency is bad enough without the bills piling up. Millions of Americans are struggling with medical debt they simply can’t pay. Sometimes, working a payment plan out with the healthcare provider just isn’t enough: Medical bills were the leading cause of personal bankruptcy in 2013.

Facts on Medical Bills

If you think credit card debt is the biggest debt Americans have, think again. Americans are paying three times as much on medical debt accounts in collections than credit card debts in collections. Even those who have health insurance have struggles with high costs of medical care.

Debt collection agencies will contact one in five – or to put it into context, nearly 51 million – Americans about outstanding medical bills.

You’re not alone if you’ve received a bill from your insurance company much larger than you anticipated: 63% of Americans report that’s happened to them.

Only four percent of people could answer all ten questions about how health insurance works, according to a recent Kaiser Family Foundation Survey.

What Happens When you Don’t Pay Medical Bills

You may want to forget about the medical bills showing up in your mailbox. They may only be reminders of something you’d rather not think about.

However, ignoring them can have serious implications:

You or Your Spouse Being Sued

When you owe serious money to a health care provider, they can send what you owe to collections, which can possibly lead to wage garnishment, home liens and other further legal actions.

Damage to Credit Score

Not paying money you owe can cause serious damage to your credit score. Low credit scores can end up costing you more money in the form of higher interest rates. Higher interest rates can affect your ability to purchase a car or a home down the line.

Being Denied Future Care

It’s not unheard of for health care providers to have policies in place that deny care to patients who have unpaid bills for previous treatments. Typically this is only for specialists, as hospitals have a legal obligation to treat anyone in an emergency situation.

Preventing Medical Debt

You can be an active part of ensuring medical debt doesn’t pile up. Taking these steps can help your financial health while you work on your physical health.

Talk to your healthcare team about how much your insurance will cover for treatments you receive.

Often, patients can ask questions to negotiate how much they spend on treatment. Patients can also simply ask about the costs upfront. Three-quarters of consumers say they’d make better health decisions if they were informed of medical costs before receiving treatment. Sometimes, for instance, blood work can be done all at once to reduce costs, rather than spread out over months.

Many hospitals are registered as non-profits and, because of that, pay significantly less in taxes.

Their non-profit status is based on them providing free or discounted health services to patients who qualify. More than 70 percent of those with medical debts aren’t offered such assistance outright. If you know you’re in a bind medically, make sure you ask your hospital if you are eligible.

Once you’ve received bills for treatment, examine them and ensure that everything is correct.

A recent NerdWallet study showed that billing errors are rampant in the health care industry and pass along unnecessary cost to patients. Spending a few minutes performing an audit of your medical bills can save you from overpaying or even paying for procedures and tests that never happened. For instance, sometimes a hospital can charge for a medication, accidentally putting on the bill that they gave it to you three times a day when in reality you only received it once a day.

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Paying off Medical Bills

It’s important to carefully consider your options in paying off medical debt. Medical debt is not reported to the credit reporting agencies until it becomes delinquent. Once in the hands of a third-party collection agency, it begins to impact your credit, and thus your financial future.

If you have an annuity or a structured settlement, you can sell payments to get out of debt.

Some people may look to liquidate assets in order to get out of debt. For example, 11% of Americans have cashed out a retirement account to pay for medical expenses. Credit counselors advice against taking a loan against your home to pay for health care bills. For most Americans, your home is your most valuable asset.